Does Anthem cover ABA therapy?

March 16, 2022

Yes, Anthem covers ABA Therapy under most conditions.

Insurers in California must give the same amount of coverage for mental problems, such as autism, as they do for physical conditions. Anthem collaborates with institutions, group practices, behavioral healthcare professionals, local communities, governmental agencies, and other entities in a coordinated effort.

Benefits of Anthem's behavioral therapy coverage plans

  • Anthem Blue Cross (Anthem) supports comprehensive physical and behavioral health treatments as an essential aspect of health care. 
  • In certain situations, ABA therapy is approved for up to 40 hours each week. Anthem Blue Cross stated it would cover the first cost of an applied behavior analysis session.
  • Mental health professionals, psychiatrists, social services, specialist nurses, and employment assistance health care experts are part of Anthem's Behavioral Health professional community. Therefore, Anthem can satisfy the requirements of individuals with mental health and addiction issues, and those with behavioral and learning impairments, as a result.
  • Professionals review the data and talk about best practices to determine how and where clinical help and advice should be provided. 
  • Professionals ensure that communication and engagement are prioritized so that clinicians can continue to offer high-quality, consistent care.

An important note

Anthem will not cover ABA treatment services until the pre-approval review procedure has been completed and approved. For ABA services, a Competency Based Assessment (CBA) prior authorization is necessary. A referral and diagnosis signed by a medical doctor is required for the first request for ABA therapy.

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